Institutional Provider & Beneficiary Summary PUF

UPDATED FILES [June 18, 2013]! Institutional Provider & Beneficiary Summary PUF

The CMS IPBS PUFs are aggregated files in which each record summarizes information for a particular institutional provider. An institutional provider refers to a hospital, a critical care facility, a skilled nursing facility, a home health agency or hospice or another similar institution providing services to Medicare beneficiaries. Information about individual beneficiaries is not reported.

The files summarize information from Medicare institutional claims paid to providers during the calendar year as well as summarizes beneficiary demographic information. There are three categories of measures in the IPBS: (1) beneficiary measures; (2) cost and utilization measures; and (3) prevention quality indicators (PQI). Summarized beneficiary measures include beneficiary demographics (e.g., breakdown of beneficiary counts by sex, age, and race), health status information (e.g., breakdown of beneficiary counts by selected chronic conditions) and the top five hospital referral regions (HRRs) where that provider’s beneficiary population resides. Summarized cost measures include actual and standardized Medicare payments, deductible and coinsurance payments, and pass-through costs. Utilization measures are summarized in terms of days, stays, visits, episodes, and readmissions. The PQI measures are based upon hospital inpatient data and include hospital admissions for specific conditions that are considered “ambulatory care sensitive conditions.” Finally, each PUF includes a variable that provides the type of the institutional facility (e.g. hospital, skilled nursing facility, home health agency). Each CMS IPBS PUF contains 111 variables.

June 18, 2013 - The CMS 2008 and 2010 IPBS PUFs and documentation were replaced.  The revision includes both updates to data and corrections to a few of the variables.

The changes include:

• Both files are recreated using more recently processed claims;
• Average risk scores are recalculated;
• Pass through costs are now included in the actual payment amount;
• Some adjustments are made to the calculation of standardized payments;
• A few variables (related to intermediate care and intensive care unit visits) are removed;
• Missing values of the hospital referral region (HRR) variable are replaced with “XX-Unknown”; and,
• Long term inpatient months are recalculated.

Content of the PUF

The most important aspects of the CMS IPBS PUFs are as follows:

• Summarizes institutional claims paid to the provider for the reference year;
• Summarizes demographic and health characteristics of the beneficiaries associated with the institutional claims to the provider level;
• Summarizes utilization and cost information to the provider level;
• Summarizes quality measures to the provider level.

In addition to the General documentation file, there are two documentation files for each IPBS PUF:

• The data dictionary and codebook file contains information about each variable on the file and its values.
• A data users document which gives the file layout for the downloadable CSV file, as well as SAS program code for creating a SAS dataset with variable formats.